Subpart 1.
Facility requirements.
For a facility to report amounts as charity care adjustments,
the facility must:
A. generate and
record a charge;
B. have a policy
on the provision of charity care that contains specific eligibility criteria
and is communicated or made available to patients;
C. have made a reasonable effort to identify
a third-party payer, encourage the patient to enroll in public programs, and,
to the extent possible, aid the patient in the enrollment process;
and
D. ensure that the patient
meets the charity care criteria of this part.
Subp. 2.
Classification as charity care
adjustments.
In determining whether to classify care as charity care, the
facility must consider the following:
A. charity care may include services that the
provider is obligated to render independently of the ability to
collect;
B. charity care may
include care provided to patients who meet the facility's charity care
guidelines and have partial coverage, but who are unable to pay the remainder
of their medical bills. This does not apply to that portion of the bill that
has been determined to be the patient's responsibility after a partial charity
care classification by the facility;
C. charity care may include care provided to
low-income patients who may qualify for a public health insurance program and
meet the facility's eligibility criteria for charity care, but who do not
complete the application process for public insurance despite the facility's
reasonable efforts;
D. charity care
may include care to individuals whose eligibility for charity care was
determined through third-party services employed by the facility for
information-gathering purposes only;
E. charity care does not include contractual
allowances, which is the difference between gross charges and payments received
under contractual arrangements with insurance companies and payers;
F. charity care does not include bad
debt;
G. charity care does not
include what may be perceived as underpayments for operating public
programs;
H. charity care does not
include unreimbursed costs of basic or clinical research or professional
education and training;
I. charity
care does not include professional courtesy discounts;
J. charity care does not include community
service or outreach activities; and
K. charity care does not include services for
patients against whom collection actions were taken that resulted in a
financial obligation documented on a patient's credit report with credit
bureaus.
Subp. 3.
Reporting categories.
When reporting charity care adjustments, the facility must
report total dollar amounts and the number of contacts between a patient and a
health care provider during which a service is provided for the following
categories:
A. care to patients with
family incomes at or below 275 percent of the federal poverty
guideline;
B. care to patients with
family incomes above 275 percent of the federal poverty guideline;
and
C. care to patients when the
facility, with reasonable effort, is unable to determine family
incomes.
